UI Tax Refund Request Employer Account # ___________________ Employer Name:__________________________________ Doing Business As: ________________________________ I, _____________________________, am the owner or legal representative for the owner, I am requesting a refund of the credit balance on the above referenced employer account. I am certain that the credit balance on this account is accurate and should be refunded to me. I am uncertain how the credit balance happened on this account. Please review my account to make certain this is a valid credit balance before issuing a refund. I certify that all quarterly reports have been accurately filed and paid, the check resulting in the credit balance has cleared the bank, and that it is unreasonable to use this credit on future tax filings. ________________________________________ _______________ signature of owner or legal representative Date _____________________________________ Phone number Return this form by FAX to 208-334-6301 or mail to: IDAHO DEPARTMENT OF LABOR 317 W MAIN STREET BOISE ID 83735-0760 If you have questions regarding your credit, call 208-332-3576 or toll free 800-448-2977.
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